Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Abstract

Background Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions. Methods We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions. Results We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches’, patients’, and clinicians’ commitments to patients’ involvement in decision making and decision coaches’ knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient’s values) (five CMOs). After decision coaching, the patient’s progress in making or implementing a values-based preferred decision can be facilitated by the decision coach’s advocacy for the patient, and the patient’s deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs). Discussion In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients’ participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients’ progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory.

A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan

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Development and Piloting of a Web-Based Tool to Teach Relative and Absolute Risk Reductions

“…Here, the tool could be offered as general information or adapted to a specific topic. It could also be used during consultations with doctors or decision coaches [ 46 ]. Other areas of application could be the provision of information to patient representatives in guideline processes or studies and representatives of self-help groups.…”

Developing a theory-driven framework for a web-based intervention to improve transition in childhood cancer survivors: a protocol of realist synthesis

“…and (2) rigour: whether a particular inference drawn by the original researcher has sufficient weight to make a methodologically credible contribution to the test of the initial programme theory 38. Zhao et al developed a relevance rating checklist based on the propositions of the initial programme theory with four items: level of relevance with mechanisms, contexts, outcomes and overall contribution to the understanding of interest concept 44. Each item contained four statements to represent four different levels of the strength of relevance, similar to a four-point Likert scale (ie, level 3: high relevance; level 0: no relevance) (online supplemental additional file 2).…”

“…Information will be captured first in the general data-extraction form. The form was developed based on previous similar studies and the Realist and Meta-narrative Evidence Syntheses-Evolving Standards 42 44 45. It will be further modified based on the propositions of the initial programme theory.…”